Bronchiolitis is a common lung infection, often caused by a virus. It most frequently occurs in infants, commonly younger than 6 months of age. Typically, bronchiolitis occurs during the winter months.
Bronchiolitis starts out with symptoms similar to those of a common cold but then progresses to coughing and wheezing. Symptoms of bronchiolitis typically last for a week or two and then go away.
In some cases, especially if your child has an underlying health problem or is a significantly premature newborn, bronchiolitis can become severe and require hospitalization.
Bronchioles and alveoli
Within your lungs, the main airways (bronchi) branch off into smaller and smaller passageways, the smallest of which are called bronchioles. At the end of the bronchioles are tiny air sacs (alveoli). ...
For the first few days, the signs and symptoms of bronchiolitis are similar to those of a common cold:
After this, there may up to one week of:
In otherwise healthy infants, the infection generally goes away by itself in one to two weeks. If your child was born prematurely or has underlying health problems, such as a heart or lung condition or a weakened immune system, the infection may be more severe and your child may need to be hospitalized.
Severe bronchiolitis may cause marked difficulty breathing or bluish-looking skin (cyanosis) — a sign of inadequate oxygen. This requires emergency medical care.
When to see a doctor
If your child experiences any of the following signs and symptoms, seek prompt medical attention:
Bronchiolitis occurs when a virus enters the respiratory system and makes its way to the bronchioles, which are the smallest of the airways branching off the two main breathing tubes (bronchi) within your lungs. The viral infection makes the bronchi swell and become inflamed. As a result, mucus often collects in these airways, which can make it difficult for air to flow freely through your lungs.
In older children and adults, the resulting signs and symptoms are generally mild. But an infant's bronchioles are much narrower than are an adult's and are more easily blocked, leading to greater difficulty breathing.
The respiratory syncytial virus (RSV), a common virus, causes most childhood bronchiolitis cases. The rest are caused by other infectious agents, including viruses that cause the flu or the common cold.
Bronchiolitis is a contagious condition. You contract the virus just as you would a cold or the flu — through droplets in the air when someone who is sick coughs, sneezes or talks. You can also contract bronchiolitis by touching shared objects — such as utensils, towels or toys — and then touching your eyes, nose or mouth.
One of the greatest risk factors for getting bronchiolitis is being younger than 6 months old, because the lungs and immune system aren't yet fully developed. Boys tend to get bronchiolitis more frequently than girls do.
Other factors that have been associated with an increased risk of bronchiolitis in children include:
Complications of severe bronchiolitis may include:
If these occur, your child may need hospitalization. Severe respiratory failure may require insertion of a tube into the trachea (intubation) to assist the child's breathing until the infection is brought under control.
If your infant was born prematurely, has a heart or lung condition, or has a compromised immune system, watch closely for beginning signs of bronchiolitis. The infection may rapidly become severe, and signs and symptoms of the underlying condition may become worse. In such cases, your child will usually need hospitalization to monitor his or her health and provide any necessary care.
Infrequently, bronchiolitis is accompanied by another lung infection such as bacterial pneumonia, which is treated separately. Reinfections with RSV after the initial episode may occur but typically aren't as severe. Repeated episodes of bronchiolitis may precede the development of asthma later in life, but the relationship between the two conditions is unclear.
Preparing for your appointment
You're likely to start by first seeing your family doctor or your child's doctor. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your time together. List your questions from most important to least important in case time runs out. For bronchiolitis, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
The doctor will likely listen to your child's lungs with a stethoscope to check for wheezing and prolonged breathing out (exhaling). These may indicate obstructed airflow in the bronchioles. The doctor may consider specific risk factors for bronchiolitis as well.
Sometimes other tests are recommended, including:
Your doctor may also ask you about signs of dehydration, especially if your child has been refusing to drink or eat or has been vomiting. Signs of dehydration include sunken eyes, dry mouth and skin, sluggishness, and little or no urinary output.
Treatments and drugs
You can treat most cases of bronchiolitis at home with self-care steps. Because viruses cause bronchiolitis, antibiotics — which are used to treat infections caused by bacteria — aren't effective against it. If your child has an associated bacterial infection, such as pneumonia, your doctor may prescribe antibiotics for that.
In more-severe cases, doctors may prescribe inhaled antiviral drugs, such as ribavirin (Rebetol). However, studies haven't found this drug to be consistently effective.
If your child has complications from bronchiolitis, a stay at the hospital may be necessary. At the hospital, your child will likely receive humidified oxygen to maintain sufficient oxygen in the blood, and perhaps fluids through a vein (intravenously) to prevent dehydration.
Lifestyle and home remedies
Although it may not be possible to shorten the duration of your child's illness, you may be able to relieve some of the symptoms and make your child more comfortable. Here are some tips to consider:
A baby may develop bronchiolitis after catching a virus from an adult or child who has a common cold. When you have a cold, wash your hands before you touch your baby, and consider wearing a face mask as well. Frequent hand washing in general reduces the spread of viruses that cause bronchiolitis. If your child has bronchiolitis, keep him or her at home until the illness is past to avoid spreading it to others.
These other simple but effective ways can help curb spread of the infection:
No vaccine available
Palivizumab doesn't interfere with childhood vaccines. The expense generally limits its use to infants at particularly high risk of RSV infection, such as those born very prematurely or with a heart-lung condition or a depressed immune system.
Last Updated: 2010-09-25
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